Mindfulness and Chronic Pain; research findings

A pile of stones on the beach - the bottom one in chronic pain?Acute pain relating to tissue injury (caused by trauma, or by surgery) is one of the most frequent reasons why patients are seeking medical care, and pain is the most common complaint in primary care overall. While most patients who have suffered injury recover and return to normal life, some will suffer chronic pain and long-lasting disabilities; 15% of patients admitted to trauma hospital after severe injury report severe persistent pain, and 15-60% (depending on procedure) of patients going through surgery end up with chronic pain [Ref. 1].

Chronic pain

Chronic pain – defined as ‘pain persisting longer than six months or beyond the regular healing time for a given injury’ – is a complex problem, which can affect both physical and emotional wellbeing of the sufferer. It is often associated with depression and anxiety, and a degree of disability that is disproportionate to the degree of injury. Whether it is caused by trauma or surgery, or other causes, such as migraines, arthritis, back pain etc., psychological interventions are increasingly playing an important role in the management of chronic pain.

Mindfulness and chronic pain

Over the last thirty years mindfulness-based interventions have become recognised for their capacity to help manage chronic pain, initially largely due to the work of Jon Kabat-Zinn at the University of Massachusetts Medical Center. A landmark study that he conducted in 1982, where 51 chronic pain patients learned mindfulness meditation in a 10-week course, showed that most patients were able to cut their pain rating by at least a third and in some cases by more than half [2].

Since the early 1980s a large number of studies have been performed, which have been able to further demonstrate the usefulness of mindfulness practices in the management of chronic pain, and a review in 2003 clearly established that mindfulness practices can lead to statistically significant improvements in ratings of chronic pain [3].

Similarly, a recent (2010) study involving  104 chronic pain outpatients at an Australian pain clinic found that mindfulness had significant (17-41%) effects on variables such as pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability [4].

Mindfulness, pain and the brain

A lot of research is going into investigating what the mechanisms in the brain are that may explain how mindfulness affects the experience of pain.  A British research team used a laser beam to produce pain, and recorded brain signals in subjects belonging to two separate groups; one consisting of mindfulness meditation practitioners, and one consisting of non-meditators. They found that the more experience with mindfulness meditation a subject had, the greater was the reduction in perceived pain. The reduction in perceived pain was accompanied by a greater activity in the prefrontal cortex (a cognitive-control centre) prior to the laser beam stimulus, which may indicate that mindfulness meditators have developed an ability to squelch anticipation of pain. Furthermore, while the laser beam was applied mindfulness meditators had a more relaxed response, which was detected as lesser activity in brain areas (cingular, insula, and S2 somatosensory cortices) that might otherwise amplify the pain experience [5].

A study in the U.S. (2011) used heat applied to the calf to produce pain, and found that mindfulness meditation significantly reduced pain unpleasantness (by 57%) and pain intensity (by 40%) ratings. Functional magnetic resonance imaging (fMRI) brain scans conducted during the pain experiments showed that mindfulness meditation influenced a number of changes in how the participants’ brains responded to pain; e.g activity was reduced in the somatosensory cortex, and activity was increased in limbic areas of the brain responsible for maintaining focus and processing emotions and pain (such as anterior cingulate cortex, orbitofrontal cortex, and anterior insula) [6].

Another U.S. study (2012), which also used functional magnetic resonance imaging (fMRI) brain scans, found that mindfulness practitioners, but not controls, were able to reduce pain unpleasantness by 22% and anticipatory anxiety by 29%. This reduction was associated with decreased activation in the lateral prefrontal cortex and increased activation in the right posterior insula during stimulation and increased rostral anterior cingulate cortex activation during the anticipation of pain, indicating increased sensory processing and decreased cognitive control [7].

Clearly these scientific findings are of great importance for our understanding of how mindfulness practice can help in managing pain, but at the end of the day what matters to the chronic pain sufferer is, of course, the ability to apply mindfulness practices to decrease their suffering. If you are interested in learning mindfulness meditation – for managing chronic pain, or for other purposes – please, don’t delay, contact me today!

References

  1. Lavand’homme, P. (2011). The progression from acute to chronic pain. Current Opinion in Anesthesiology 24, pp. 545-550.
  2. Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4 (1), 33-47.
  3. Baer, R. (2003). Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. Clinical Psychology: Science and Practice, 10 (2) 125-143
  4. Schütze, R., Rees, C., Preece, M., Schütze, M. (2010). Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain 148, pp. 120-127.
  5. Brown, C. A., Anthony K.P. Jones, A. K. P. (2010). Meditation experience predicts less negative appraisal of pain: Electrophysiological evidence for the involvement of anticipatory neural responses. Pain 150(3), pp. 428-438.
  6. Zeidan, F., et al. (2011). Brain mechanisms supporting the modulation of pain by mindfulness meditation. Journal of Neuroscience 31(14), pp. 5540-5548.
  7. Gard, T., et al. (2012). Pain Attenuation through Mindfulness is Associated with Decreased Cognitive Control and Increased Sensory Processing in the Brain. Cereb. Cortex 22 (11), pp. 2692-2702.